Differential diagnosis includes scalded skin syndrome
The differential for an infant with peeling skin includes staphylococcal scalded skin syndrome, physiologic desquamation, and infantile seborrheic dermatitis.
Staphylococcal scalded skin syndrome is a blistering skin disease induced by exfoliative toxins of Staphylococcus aureus. Toxins enter the skin, most often from the circulation, and disrupt intercellular linkages in the epidermis.9 Patients have generalized erythema, fever, and skin tenderness followed by the formation of large bullae, which rupture with slight pressure (Nikolsky sign). Rupture of these bullae results in extensive areas of denuded skin. These lesions do not scar because epidermal disruption occurs superficially.10 There is no hair loss.
Diagnosis is primarily clinical, but is supported by bacterial culture results. Sepsis can be a comorbid condition.
Physiologic desquamation is a common benign condition of full-term and post-date neonatal skin. Fine, diffuse scaling and peeling typically begin on the second day of life and last a few days. There is no hair loss or shiny membrane formation.11
Infantile seborrheic dermatitis, or “cradle cap,” is a common condition characterized by erythema and greasy white-to-yellowish scales on the scalp, forehead, eyebrows, cheeks, paranasal and nasolabial folds, retroauricular area, chest, and axillae.12 This condition usually develops in the first 3 to 4 weeks of life, but immunocompromised neonates often have generalized scaling and desquamation at birth.13 While hair loss is not caused by the primary process, aggressive scale removal during treatment can cause secondary hair loss. The etiology is unknown, but some evidence points to an abnormal host response to the yeast Malassezia.12